Healthcare bill teeters towards enactment…

We were fortunate that our time in Washington at the same time the government was trying to get its healthcare bill through Congress. I say ‘government’ when in actual fact the government (ie the executive office functions overseen by the White House) when – unlike the strong arm approach of LBJ (or even the Bush administration) – the President had little or nothing to do with the drafting of this bill. Rather his contribution seems to have been cast more in the strategic framing of the bill:

His aim is to establish a long-term political direction — one centered on a more activist government that shapes and polices the market to strengthen the foundation for sustainable, broadly shared growth. Everything else — the legislative tactics, even most individual policies — is negotiable. He wants to chart the course for the supertanker, not to steer it around each wave or decide which crates are loaded into its hull.

To the legislation itself, the Economist gives two reasons to back it: one, decency; and two cost control. The second first:

America’s health-care system is a nightmare of perverse incentives. Because employer-provided health insurance is not considered to be a taxable benefit, people feel insulated from the real cost of their coverage and consequently over-consume. Because hospitals and medical practices in many areas face too little competition, they charge absurdly too much even for simple procedures. Because of the rapacity of America’s lawyers, the fear of lawsuits encourages doctors to practise “defensive” medicine, again driving up costs.

This is the libertarian trap that prefers to let freedom reign which encourage the country to consume resources simply to game the system. Thus the cost of the UK’s universal system come in at around 8% of its GDP, whereas the US system which currently excludes 45 million of its population, eats up 16% of its gross domestic product.

Even ‘Obamacare’ will leave a significant number of people outside the system. And there will be no ‘public option’ (a government-run insurance option). Medicine will remain private, but it will be regulated into ‘exchanges’ or government regulated markets in which competition will exert a downward pressure on costs, with a tax being implemented on high-cost insurance plans.

And on the decency thing, for the Economist it is simply about closing an obvious gap between the US and the rest of the developed world. And it is not about covering those currently excluded, but those wage earners whom the insurance companies consider too bad a risk to make money on:

…the much larger number of people who fear falling into that position through losing their jobs; and the larger number again who cannot get affordable insurance because they have an existing medical condition, or because they are too old, or because they have exhausted the “lifetime caps” imposed by insurance companies.

That said, it is still no done thing. House Democrats have – in the words of one Congressman we met last week – ‘lost the narrative’ to outlying rumours like Sarah Palin’s Death Panel story… And the Republicans are counting on fears that these reforms will play into their hands come the mid term elections in November…

That is still a long way away. Obama’s pitch to his party’s Congress caucus yesterday was that this was a straight down the middle bill, which balances fairness with an attempt to bring down America’s sky high healthcare costs… Turning the US Supertaker will take a lot longer than 7 or 8 months…

And there are a dozen other reasons to kick the government party (not least the stubbornly persistent 10% unemployment rate)… Some of those waverers must now be calculating that it is as better to be hung for stealing the proverbial sheep than a lamb…


  • The death panels story, was a silly scare tactic, the phrase clearly being used to drum up anti healthcare feeling. But there are panels in the UK who decide which medicines are used. NICE has had to be shamed into allowing the use of at at least one cancer drug it tried to suppress on the grounds of cost.

    This is not to say that the US does not need to upgrade its healthcare system, just that they need to steer as far away from the UK ‘universal’ system as they can possibly get.

    As for Obama taking a back seat and letting the legislators sort it out. I understand his henchman Rahm Emanuel has accosted more than one senator, naked, in the showers no less! to er, argue the case.

    I do not call sending the heavies in, keeping a distance.

  • Michaelhenry

    martin mcguinness was right to call the s.d.l.p leader a silly billy for complaining that she was snubbed by president barack obama,this was after all an irish event,the st patricks day meeting,plus the s.d.l.p have made it clear for years that they do not want to be irish and do not want to stand in elections in 26 of irelands counties.

  • Michael

    I thought the SDLP were in talk with Labour? As far as I know they have always supported and argued for a united Ireland, they just have not killed for it.

    As to meeting Obama, each to their own. This smug, superior politician must have something going for him, even though I cannot see it.

  • Michaelhenry

    obama has the suppurt of most of the american people going for him pippakin,while the s.d.l.p shun most of the irish people.

  • Michaelhenry

    Not according to the latest polls he doesnt.

    I am not a supporter of the SDLP but at least they campaign for Irish unity in the north, which is more than can be said for the gutless gobshites this side of the border.

  • Michaelhenry

    polls mean nothing,most of the american people suppurt obama,get over this fact,while the s.d.l.p are to yellow to look for suppurt with most of the irish people.

  • Mick Fealty

    Michael Henry wins the Prize for most egregious Non sequitur of the week…

  • Michaelhenry

    A lot of Americans voted for Obama, that does not mean they support him now.

    I think Americans are a bit like us: a caring people who, politically, lean to the right. Obama is a left wing politician who knows how to ‘sell himself’. There he was a young charismatic BLACK man, making much of his modern approach, right down to his Blackberry. He even won the support of Colin Powell! so eager was the country for a serious black President.

    A lot of that initial support has dissipated, he had better come up with something good to get a second term. And sounding superior about a man with a van, will not do it! It even suggests he had no idea how many Americans own and drive vans, that little error cost them Ted Kennedys seat.

  • Michaelhenry

    thanks mark,your words are an inspiration to thought.

  • Who is Mark?

  • Comrade Stalin

    This is not to say that the US does not need to upgrade its healthcare system, just that they need to steer as far away from the UK ‘universal’ system as they can possibly get.

    The UK system does surprisingly well given that it is relatively cheap. Other countries have better standards of care and better health levels – but they pay a lot more for it.

    A lot of Americans voted for Obama, that does not mean they support him now.

    Americans voted for Obama who had healthcare reform in his manifesto. If they thought that healthcare reform would be bad, they didn’t show this when they voted.

    I think Americans are a bit like us: a caring people who, politically, lean to the right.

    What gives you this weird idea ? What does “lean to the right” mean anyway ?

    A lot of that initial support has dissipated, he had better come up with something good to get a second term.

    The problem for republicans will arrive when it becomes clear that their predictions of doom and gloom have not unfolded.

  • Michaelhenry

    obama did not stand in that election for ted kennedys seat pippakin,but with the obama name in the next race he will win a 2nd term no problem, he even won the noble peace prize,people around the world respect him.

  • Comrade Stalin

    It is one thing to campaign for healthcare reform, and win support. It is quite another for those supporters to watch the shenanigans in Washington and still support it. I am not entirely sure Nancy Pelosi knows what she is talking about, and that when shes telling the time!

    The UK system does indeed do well with what its got, and that is just it. No one wants to be told they cannot get a drug on the NHS because it will only prolong their life for a period deemed to short by some quango.

    Lean to the right, well would you call F/F socialist? as for F/G. What was it Oscar Wilde said – bread on bread…

    I agree Obama has a couple of years to get it right, voters have such notoriously short memories!

  • Michaelhenry

    thanks mick fealty your words are an inspiration to thought.

  • Michaelhenry

    I think the Nobel prize even embarrassed someone as brass faced as Obama.

    He did not run for the Kennedy seat, but he did campaign for it…

    I cannot know about a second term, I dont even know if I want him to win it!

  • Michaelhenry

    thats your problem pippakin right there,you can complain but you can not suppurt.

  • Coll Ciotach

    anyone hear if Pat Ramsey has decided to pack in?

  • Michaelhenry

    I am fortunate not to have to make a choice! I have relatives there I will leave it to them.

    Coll Ciotach

    I know Im asking for it, I can smell it! But, please, enlighten my ignorance, who is Pat Ramsey?

  • Coll Ciotach

    Just a heads up for you guys

  • Coll Ciotach

    Pat Ramsey SDLP MLA Now I know!

    Unfortunately I have no idea if or when he will decide to ‘pack in’!

  • Coll Ciotach

    I think it is the council, and I think he is announcing it or due to soon – dbl jobbing strikes again – another seat for SF or will the dissidents make a burst for glory? – any chance of a thread? We need to leave this one to those who care about boking Americans

  • coconnor

    The SDLP don’t run in the south because they are a member of the Party of European Socialists. PES member groups do not run against other PES members (i.e. Irish Labour), this is also a significant factor in why British Labour don’t run candidates in the north.

  • Michaelhenry

    i thought it was because the s.d.l.p do not like being irish coconnor.

  • Kevsterino

    I think Obama would have done better to get Congress to vote on his program first, up or down. All this manipulating of the legislation by deep-pocketed insurance companies has turned it into an unrecognizable mess.

    The structure for delivering health care in my country has been dysfunctional for years and with the aging of the baby-boomers will only get worse. Whether Obama is the one to fix it is still up in the air at this point, but it will still have to be fixed.

    Clearly, nothing good will come from doing nothing about it.

  • Nice headline piece.

    To which I would add a couple of other numbers which must be in there somewhere, but I seem to have missed:

    Despite the recession, 2009 was a boom year for influence peddling overall with business and advocacy groups shelling out $3.47 billion for lobbyists to represent them on all kinds of issues, according to the nonprofit group Center for Responsive Politics.

    Much of that money went to fight the health reform battle, according to Center for Public Integrity data. Businesses and organizations that lobbied on health reform spent more than $1.2 billion on their overall lobby efforts. The exact amount they spent on health reform is difficult to quantify because most health care lobbyists also worked on other issues, and lobby disclosure rules do not require businesses to report how much they paid on each issue.

    From an industry perspective, it was money well spent. A close look at the health reform bills that passed the House and Senate show lobbyists were apparently effective at blocking provisions like a robust government-run insurance program, and blunting the effect of cost-cutting measures on health care companies.

    Such a labour of love-and-money contributed to the employment statistics, too:

    A Center for Public Integrity analysis of Senate lobbying disclosure forms shows that more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009.

    Obama achieved what Clinton couldn’t: the beginnings of a clean-up of the US healthcare mess. And almost in his first year. Onwards and upwards!

  • Kevsterino

    I completely agree Medicare looks like going bust if they do nothing.

    The shambles in Washington is ridiculous and unnecessary. I have never understood why they think it is so difficult to, for example, have insurance companies do business nationwide. Each state has its own insurance companies and of course that is a recipe for disaster.

    The argument seems to be that different states have different standards. It seems to me that introducing minimum required standards would be a relatively painless thing to do.

    TORP reform is another one that should be fairly painless to introduce, unless you are a lawyer.

  • Comrade Stalin

    No one wants to be told they cannot get a drug on the NHS because it will only prolong their life for a period deemed to short by some quango.

    Uhm, do you really think that healthcare systems around the world prescribed drugs with no significant evidence showing that they work ? Except possibly in the USA, where bribery of the medical profession by the pharma companies is rife.

  • Comrade Stalin

    I hope I go quietly in my sleep, but if I am ever very sick and there is a drug which will prolong my life and quality of life for a year or so. I do not want to be told that drug is too expensive. Putting a value on someones life is not what the NHS was meant to be or should be doing.

    I know the NHS has changed a bit, but time was you could not get NHS care if you went private for one part of a procedure. It was all private or all NHS. I hope that is one of the changes they made.

  • Comrade Stalin

    The above did happen, thankfully not to me, but it made headlines at the time.

  • DerTer

    I think the following extract from a letter to the London Independent, reproduced in the current edition of The Week, will be of some interest, and I would draw it to the attention particularly of those who think that the US should steer away from the NHS model.
    “Having just survived a life-threatening medical experience, I can only express my thanks to the NHS: from the National NHS helpline, which determined that an ambulance was required; to the paramedics, who were knocking on the door within five minutes; to the multitude of medical staff who struggled to find the cause of my condition. The last used a variety of examination procedures including ECG, X-ray and full-body scan to identify the problem and start the treatment that saved my life…With nine stitches in my head and eight units of blood in my body, I spent the next five days as an in-patient under observation…The American critics of the NHS know nothing of which they speak. Being an American living in Britain, I prefer the money-losing socialist NHS, which provides an adequate health service for 100% of the population using 8% of GDP, to the American for-profit system which provides a more-than-adequate service for 80% of the population costing 16% of GDP.”
    I might add that my wife and I have both had highly satisfactory experience of healthcare provision in both the US and NI during the last couple of years; however, the treatment in the US was ludicrously expensive – fortunately covered by our travel insurance.
    I also think I am right in saying that the US and Mexico are the only OECD countries that do not have universal health insurance coverage – public, private or a mixture of the two (the ‘mixture’ model being the one that applies in the RoI).
    Another statistical comparison (taken from 2007 OECD figures) is that although the US spends more than twice as much per person in terms of health expenditure as the UK, the US actually does slightly worse than the UK as regards average life expectancy. It is also estimated that lack of health insurance contributes to an estimated 45,000 deaths a year in the US.
    I’ll stick with the NHS model thanks!

  • DerTer

    I did not say the NHS was no good, only that it was not good enough, and is forced to make decisions based on cost.

    There are a great many happy endings in the NHS and those now include some Breast Cancer patients who had to go to court to force the NHS to pay for their particular care.

  • DerTer

    pippakin – Don’t be so defensive; I didn’t say, or even hint, that you said that the NHS was no good! And of course the NHS is not perfect, but it’s a lot closer to perfection than the current position in the US, and I venture to say the NHS will remain closer, even if the Obama plan gets the go-ahead this evening. As for “decisions based on cost”? – sounds very like the Palin ‘death panel’ accusation. But what about the following decision based on cost: “I need to see a doctor; but I can’t afford it”.
    It is also well to remember (1) that many of the proposals in the Obama Bill actually figured in previous Republican efforts on healthcare reform; and (2) that because the ‘public-option’ has been rejected, there will still be a substantial number of people not covered under the proposed new regime.
    This points to the frighteningly fundamental problem that US politics have become so amazingly partisan. When I began studying US politics many moons ago, one of the interesting things for Europeans was how little ideological difference there was betwen the two big parties. (I seem to remember that once he developed presidential ambitions, it was a toss-up for Eisenhower whether he stood as a Democrat or Republican.) Now, however, there is a depth of bitterness, intolerance and ideological bigotry across the isle that would be a wonder to behold if it was not so essentially corrupting and corrosive of progress. As a fairly frequent visitor to the US and as an avowed Amerophile (I just made that word up!) it makes me very sad to see healthcare as the latest victim of this.

  • DerTer

    I did not mean to sound defensive! It just seems to me that if you are starting from scratch, with all the examples before you, you aught to be able to do much better than the NHS.

    The NHS is old and creaking. It was designed for people who lived three score years and ten, if they were lucky! It did not factor in all the marvelous drugs available now. Or indeed the frightening new illnesses like Aids and all these hospital aquired infections.

  • DerTer

    pippakin – I regret that you revert to meaningless cliches about ‘old and creaking’, which tell us nothing substantial about your critique of the NHS model. I repeat, it is not perfect, but I want to know what your alternative is. I know you have given some indicators as to your own preferences here; but would you mind spelling out exactly what you would do if you were starting with a clean sheet. (I note, by the way, that Fine Gael at their weekend conference are backing the Dutch model – but I haven’t had time yet to find out what this consists of.)

  • DerTer

    There is fascinating live coverage on ABC News of the House healthcare debate at

  • DerTer

    In the NHS I would ensure it is ‘national’ and not ‘universal’. I would also like much more money spent on it.

    For America? I am not sure. I have already said I would open state borders. I would make sure malpractice claims deemed by the courts to be frivolous were paid by the claimant. As for the equivalent of national insurance. I would start big and work down.

    Ideally what I would like is for the US to take the best of all and incorporate them into their new system. I doubt that will happen though.

  • scarecrow

    I’m reading US vets won’t have their health care protected under this, another scare story like the death panels, or is there anything to it. Also read they couldn’t afford to purchase health care since they’re paid so low?

    Anyone got any updates on this, or know if it is true? An awful lot of misinformation during this.

  • Comrade Stalin

    I hope I go quietly in my sleep, but if I am ever very sick and there is a drug which will prolong my life and quality of life for a year or so. I do not want to be told that drug is too expensive. Putting a value on someones life is not what the NHS was meant to be or should be doing.

    Your problem seems to be with the fact that some drugs are expensive and there isn’t an infinite supply of money to pay for them. What’s that got to do with the NHS ? Do you think private insurers have a bottomless pit of money they use to fund every possible way to keep people alive as long as possible ? US life expectancy statistics, which are about the same as ours, suggest otherwise.

    It did not factor in all the marvelous drugs available now.

    That’s bollocks for a start. New treatments are being tested and made available on the NHS all the time. Whatever gave you the idea that this wasn’t the case ?

    The performance of any healthcare system should be measured by (it amazes me that this has to be pointed out to some people) how effective it is at curing sick people and keeping them alive for longer. Not by prescribing every gimmicky new wonder-drug that is pushed on us by big pharma.

    There are a great many happy endings in the NHS and those now include some Breast Cancer patients who had to go to court to force the NHS to pay for their particular care.

    That’s also bollocks. Herceptin was tested and found to have limited effectiveness. It was prescribed because the pharmaceutical company manipulated the breast cancer charities to pressurize the government to make it available. This was a political decision which overrode the medical advice. As a result, the NHS is being ripped off and money which could have been spent on medically justifiable things is now being spent on medically unjustifiable things.

    The obsession with wasting money on expensive wonder drugs which don’t actually do very much is the reason why the Americans pay double for their healthcare and have health standards substantially similar – and in some cases worse – when compared with ours.

  • Comrade Stalin

    I wish you were right, but when I wrote that some had to go to court to get their treatment. I was telling the truth. There is also the subject of the postcode lottery.

    The thing about drugs which is unquantifiable is what may work for one may not work for another, or perhaps not as well. I believe if someone has a life threatening illness, the knowledge that all is being done that can be done is of therapeutic as well as physical value.

    I am not saying the NHS is bad, not at all. I am saying that if you are starting from scratch you should be able to do better.